Epidemiology and evaluation: steps toward hypertension treatment in the 1990s

Article Abstract:

When high blood pressure (hypertension) is defined as systolic blood pressure of 140 millimeters of mercury (mm Hg) or higher, or a diastolic pressure of 90 mm Hg or higher, half of the US population between the ages of 65 and 74 is hypertensive. Blacks are significantly more likely to suffer from hypertension, and two thirds of black women in this age group are affected. Current treatment is based of the 1988 guidelines of the Joint National Committee for the Detection, Evaluation, and Treatment of High Blood Pressure. However, these guidelines are already out of date. The standard therapy relies heavily on diuretics, which cause undesirable metabolic changes. Both diuretics and beta blockers increase cholesterol, especially low-density lipoprotein cholesterol and triglycerides, an undesirable side effect. Left ventricular hypertrophy (LVH), enlargement of the left ventricle of the heart, increases the risk of coronary artery disease; diuretics do not affect LVH. There is also a relationship between hypertension, obesity, and diabetes; diuretics and beta blockers may have an adverse effect on diabetics. For mild hypertension, the benefits of drug treatment have been hard to demonstrate, and the adverse effects of diuretics and beta blockers may outweigh any benefit. Older patients have decreased heart output and increased rigidity of the peripheral blood vessels, so it is reasonable to assume that the ideal medication would be a vasodilator that does not decrease output, while relaxing the peripheral blood vessels. However, all treatment must be individualized. Of the five major classes of antihypertensive drugs, diuretics, beta blockers, angiotensin converting enzyme (ACE) inhibitors, calcium antagonists, and alpha blockers, each have their place in the treatment of high blood pressure. Although diuretics are being used less frequently, they may be helpful in small doses if supplementary drug treatment is required. Up to half of patients with hypertension can be maintained on one drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly, Evaluation, Demographic aspects

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Conclusion

Article Abstract:

The Second International Symposium of Rilmenidine, held in Paris in March 1988, brought to light several promising avenues of research. Among them are the responses of vascular smooth muscle to alpha-2-adrenoreceptor agonists, and the role of endothelial relaxing factor, and the receptors in the brainstem which modulate blood pressure in response to clonidine, rilmenidine, and related drugs. These receptors, apparently located in the medullary nucleus reticularis lateralis, are not alpha-2-adrenoreceptors, but specifically respond to imidazolines like clonidine. It will be important to discover the natural substrate of these newly described receptors. Data presented at the Symposium firmly establishes the effectiveness of rilmenidine for the treatment of mild-to-moderate uncomplicated essential hypertension. Furthermore, the drug does not have the adverse effects on alertness which are associated with clonidine. Rilmenidine does not raise urea, creatinine, or uric acid levels, and does not cause any imbalance in the excretion of electrolytes. The drug does not enhance the effects of diuretics, and does not influence sugar metabolism in diabetic patients. Rilmenidine has no effect on serum cholesterol or triglycerides. The imidazoline derivatives, like clonidine, are effective, but have not been fully utilized due to troublesome side effects. Now the related oxazoline derivative rilmenidine shows promise not only of effective treatment, but also of founding a new family of therapeutic compounds. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Imidazole, Clonidine, Rilmenidine

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Similar abstracts:

• Abstracts: Treatment of hypertension in diabetic patients. Hypertension in the elderly

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